Poster Author of 1 e-Poster
EE-035 - The challenging diagnosis of intraductal papillary neoplasm of the bile duct: CT and MRI findings of a rare entity
Author of 1 Presentation
EE-035 - The challenging diagnosis of intraductal papillary neoplasm of the bile duct: CT and MRI findings of a rare entity
Abstract
Objectives
To describe radiological findings of intraductal papillary neoplasm of the bile duct (IPNB).
Background
IPNB is relatively new clinical entity including majority of intraductal papillary cholangiocarcinoma, and its precursor lesions. IPNB is defined as tumor which shows papillary proliferation of neoplastic biliary epithelial cells with fibrovascular stalks within the bile duct, and macroscopic or microscopic existence of mucin. IPNB is considered to be counterpart of intraductal papillary mucinous neoplasm of the pancreas.
Imaging findings OR Procedure findings
Typical imaging findings are diffuse biliary dilatation with multifocal superficial papillary or plaquelike lesions within the bile ducts. In contrast to other types of cholangiocarcinoma, in this type of intraductal cholangiocellular carcinoma dilatation of both upstream and downstream bile ducts is seen. IPNB can also present as intraductal cast-like lesion with dilatated lobar or segmental bile ducts filled with soft tissue material. On magnetic resonance imaging (MRI), these tumors are seen as moderately hyperintense lesions with branching pattern, filling lobar or segmental bile ducts. Parenchymal atrophy of affected segments is almost always present. Loss of visualization of bile ducts filled with tumor, together with peripheral bile duct dilatation are seen on magnetic resonance cholangiopancreatography (MRCP).
Conclusion
Although rare, IPNB lesions have characteristic imaging findings which allow preoperative diagnosis in majority of cases. Since these tumors have better prognosis than other types of cholangiocarcinoma, it is important to correctly characterize them and provide the optimal surgical treatment for the patients.
Author of 1 Presentation
SS 8.1 - Impact of new nodal staging guidelines in rectal cancer (ID 871)
Abstract
Purpose
The ESGAR-guidelines on MRI of rectal cancer advise the use of specific nodal staging criteria to determine the N-stage for primary rectal cancer staging, mainly aiming to avoid overstaging. These criteria were adapted from the Dutch national colorectal cancer guidelines that were introduced in 2014. The aim was to explore the clinical impact of the implementation of these Dutch guidelines on primary nodal staging outcomes in the Netherlands.
Material and methods
The primary staging MRIs of n=96 rectal cancer patients (from 3 Dutch centers) were analyzed: 48 patients from <2014 (pre-guideline) and 48 from >2014 (post-guideline). A dedicated reader determined the N-stage (N0/N1/N2) for each case, blinded to the original reports, using the criteria from the Dutch/ESGAR guidelines, where nodes are considered positive when ≥9mm, 5-8 mm with two morphologically suspicious criteria (round/irregular/heterogeneous), or <5 mm with 3 suspicious criteria. Results were compared to the N-stage in the original clinical reports, derived from the hospitals’ patient databases.
Results
Before 2014, the N-stage determined using the Dutch/ESGAR criteria was concordant with the original reports in 79% of the cases, the remaining 21% were downstaged when the guideline was applied. After 2014, scorings were concordant in 96% of the cases, 2% were upstaged, and 2% were downstaged. The difference in concordant/discrepant findings before and after 2014 was significant (P=0.014 Chi-square).
Conclusion
The results of this exploratory study suggest that the introduction of more strict nodal staging criteria has led to a significant reduction in overstaging of the nodal status in rectal cancer in the Netherlands.
Presenter of 1 Presentation
SS 8.1 - Impact of new nodal staging guidelines in rectal cancer (ID 871)
Abstract
Purpose
The ESGAR-guidelines on MRI of rectal cancer advise the use of specific nodal staging criteria to determine the N-stage for primary rectal cancer staging, mainly aiming to avoid overstaging. These criteria were adapted from the Dutch national colorectal cancer guidelines that were introduced in 2014. The aim was to explore the clinical impact of the implementation of these Dutch guidelines on primary nodal staging outcomes in the Netherlands.
Material and methods
The primary staging MRIs of n=96 rectal cancer patients (from 3 Dutch centers) were analyzed: 48 patients from <2014 (pre-guideline) and 48 from >2014 (post-guideline). A dedicated reader determined the N-stage (N0/N1/N2) for each case, blinded to the original reports, using the criteria from the Dutch/ESGAR guidelines, where nodes are considered positive when ≥9mm, 5-8 mm with two morphologically suspicious criteria (round/irregular/heterogeneous), or <5 mm with 3 suspicious criteria. Results were compared to the N-stage in the original clinical reports, derived from the hospitals’ patient databases.
Results
Before 2014, the N-stage determined using the Dutch/ESGAR criteria was concordant with the original reports in 79% of the cases, the remaining 21% were downstaged when the guideline was applied. After 2014, scorings were concordant in 96% of the cases, 2% were upstaged, and 2% were downstaged. The difference in concordant/discrepant findings before and after 2014 was significant (P=0.014 Chi-square).
Conclusion
The results of this exploratory study suggest that the introduction of more strict nodal staging criteria has led to a significant reduction in overstaging of the nodal status in rectal cancer in the Netherlands.